HomeMy WebLinkAbout110506 - Campaign Finance Report - Julie Schultz9
Texas Ethics Commission PO. Box 12070 Austin, Texas 78711-2070 (512)463-5800 (TOO 1-800-735-2989)
CANDIDATE t OFFICEHOLDER FORM etOH
CAMPAIGN FINANCE REPORT COVER SHEET PG 1
1 ACCOUNT# 2 Total filed:
The C/OH Instruction Guide explains how to complete this form.
J I
MSIMRSIMR FIRST MI3 CANDIDATE I OFFICE USE ONLY
OFFICEHOLDER
NAME I M\2S . Dale ReceivH AND
,.... , . M:e.rrltd~..
lAST SUFFIXI NICKNAME 4 '.12 pM.
MAY 0 6 2011
iQJ::I '~EeRE[)
Receipl 1/ i Amount
AREA CODE "-.J PHONE NUMBER EXTENSION5 CANDIDATE! Date Processed OFFICEHOLDER
PHONE (c)1 <J ) Co'? 4 -l8~b
Date ImagedMSIMRS/MR FIRST MI
TREASURER
NAME
6 CAMPAIGN
~ . . . .. ..... . ....
NICKNAME lAST SUFFIX
JO()t'.S
STREET ADDRESS (NO PO BOX PLEASE); APT I SUITE II; CITY; STATE; ZlPCODECAMPAIGN
TREASURER
7
It (.. \rJalow Loo f ADDRESS
(residence or business)
C.O II ~a.,e.. ~t Ltt 0" I ~
AREA CODE J PHONE NUMBER EXTENSION8 CAMPAIGN
,
I
TREASURER
PHONE
REPORT TYPE 15th day after campaign treasurer January 15 30th day before election Runoff0 appointment (officeholder only)
8th day before election Exceeded $500 limit Final report (Attach CIOH • FR) i 0 0July15 ~
r:.·-O·-P-E-R-IO-O"----TM,nth Day Vear Monlh Day Vear
THROUGHCOVERED ! Lf // It.} S-/~/II
ELECTION DATE ELECTION TYFE
Month Day I
t; iX' Generat o Special
11 ELECTION
Primary Runoff14-/ II
,
OFFICE HELD (if any) '13 OFFICE SOUGHT (if known)12 OFFICE I. C..., H€j€. S\-~~pI\ '5
www.ethics.state.tx.us Revised 04/21/2010
Y\o\'\-€-, C-.h.-. ~c...:1 1'12..~e.. --~--"~--------~--~--------~~~------------~--~--~~~~~~~=~--~~~--~~~--------,--~
14 NOTICE IOF DIRECT DIRECT CAMPAIGN EXPENDITURES ARE CAMPAIGN EXPENDITURES MADE BY OTHERS WlTHOUT THE CANDIDATE'S PRIOR CONSENT OR APPROVAL.
CAMPAIGN CANDIDATES ARE REQUIRED TO DISCLOSE THIS INFORMATION ONLY IF THEY RECEIVE NOTIFICATION OF THE DIRECT CAMPAIGN EXPENDITURE.
EXPENDITURE
BY OTHER
INDIVIDUALS
additional pages
Name
Address I PO Bo,: A.pt I SuUe #; City; Stale: Zip Cnrla
GOTO PAGE 2
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TOO 1-800-735-2989)
CANDIDATE I OFFICEHOLDER REPORT: FORM C/OH
SUPPORT & TOTALS COVER SHEET PG 2
16 ACCOUNT /I (Ethics Commission Filers) 15 C/OH NAME JUll e
17 NOTICE THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT THE
FROM CANDIDATE IOFFICEHOLDER. THESE EXPENDITURES /JAY HAVE BEEN MADE WITHOUT THE CANDIDATE'S OR OFFICEHOLDER'S KNOWLEDGE OR
POLITICAL CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE OF SUCH EXPENDlllJRES.
COMMITTEE(S) i COMMITTEE NAME
COMMiTTEE TYPE
I
GENERAL
o SPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME
o additional pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
18 CONTRIBUTION ! 1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN
TOTALS PLEDGES. LOANS. OR GUARANTEES OF LOANS). UNLESS ITEMIZED $ 2 2~5.~
2. TOTAL POLITICAL CONTRIBUTIONS
(OTHER THAN PLEDGES. LOANS, OR GUARANTEES OF LOANS) $ 5,415 ,c:ro
EXPENDITURE
TOTALS
3. TOTAL POLITICAL EXPENDITURES OF $50 OR LESS. UNLESS ITEMIZED 1$-0
r------~----------------------------------Ir-------------~
I 4. TOTAL POLITICAL EXPENDITURES $ 7, 185. crJ
.rl------~----------------------------.----------------------~ CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY BALANCE OF REPORTING PERIOD $ fLI. ~
OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE LOAN TOTALS LAST DAY OF THE REPORTING PERIOD
19 AFFIDAVIT
I swear. or affirm, under penalty of perjury. that the accompanying report
is true and correct and includes all information required to be reported by
me under Tille 15. Election C e.
AFFIX NOTARY STAMP i SEAL ABOVE
SVtO't{0 and Subscribed before • this the
lo day of witness my hand and seal of office.
~~~~~~,~·~~~t~~~~~~Sic Title of officer administering oath
said
20 ~l.c....I_. . to certify which.
Revised 04/21/2010
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
I POLITICAL CONTRI BUTIONS
SCHEDULEAOTHER THAN PLEDGES OR LOANS
/1 Total pages Schedule A:
The Instruction Guide explains how to complete this form. L
3 ACCOUNT # (Ethics Commission Filers) 2 FILER NAME
!Jl..l.li e. Sch.l...l+z.-r
5 Full name of contributor o out-of-slale PAC (100: ) /7 Amount of I 8 In-kind contribution
contribution ($) I description (if applicable)
4 Date
) I6 /";",;b,,o;"'~"~'
I I
I
/ (If travel outside of Texas, complete Schedule T)
9 Principal occupation I Job title ~structionS) \~~ 11~IOyer (See Instructions)
Date I I Amount of I In-kind contributionAOf~mdbm~~~~"","~
! contribution ($) description (if applicable)
Contributor ifS: City: Sta Z,p Code ./
I
I
I/1 ~ I
/ (If travel outside of Texas com plete Schedule T)
Principal tupation I Job t~nstructions) i Employer (See Instructions)
I
Date '--~name of contributor o out-of-slale PAC (100: ) Amount of I In-kind contribution
contribution ($) I description (if applicable)
Contributor address; City; State; Zip Code I
I
I I
(If travel outside of Texas, complete Schedule T) I
Principal occupation I Job title (See Instructions) Employer (See Instructions)
I
Full name of contributor o oul-of-state PAC (ID#: ) I Amount of I In-kind contribution /
contribution ($) I description (if applicable)
Date
I
Contributor address; City; State: Zip Code I
/ I I
iI
II (If travel outside of Texas complete Schedule T) I
Principal occupation I Job title (See Instructions) I Employer (See Instructions)
I !
I
I
Date Full name of contributor o out-of-sl.le PAC (100: Amount of I In-kind contribution /
1/ contribution ($) I description (if applicable)
Contributor address; City; State; Zip Code
' ~/ .
r-______~________________.____r_-------.'-i~..(If trave! outside !f Texas, complete SChed~
Principal occupation I Job title (See Instructions) Employer (See Instructions) ,
!
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC, please see instruction gUide foradditional reporting requirements_
www.ethics.state.tx.us Revised 04/2112010
POLITICAL CONTRIBUTIONS
OTHER THAN PLEDGES OR LOANS
Jullie Merrifield Schultz
College Station City Council Place 5
Schedule A ( supplemental)
Contribution
--_._.----
•
4/28/11 Don Lewis 1511 South Texas Ave CS 77840 individual $200.00
4/28/11 Ivan & Candy Olson 3008 Coronado CS 77845 individual $150.00
4/28/11 Mike & Kara Holmgreen 5118 Belle Bend CS 77845 individual $250.00
4/28/11 Mark & Deanie Dudley 8 Lori Lane CS 77845 individual $150.00
4/28/11 Bob Gravis 5113 Whistling Straights Dr CS 77845 individual $500.00
4/28/11 J R Birdwell 3 Forest Dr CS 77840 individual $250.00
4/29/11 Michael Davis 729 S Rosemary Bryan 77802 individual $400.00
4/29/11 James Jett 6161 Imperial Loop; St 101 CS 77845 individual $300.00
5/6/11 Joe & Janet Johnson P.O. Box 800; Coleman, TX 76834 individual $250.00
5/6/11 Bill & Peggy Lero 4421 Nottingham Bryan 77802 individual $200.00
5/6/11 Kenny & Una Lawson 2901 Camelot Bryan 77802 individual $500.00
-_._-Total for 5/6/11 reP9rt~__ --$3.150.QO
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TOO 1-800-735-2989)
PLEDGED CONTRIBUTIONS SCHEDULE B
The Instruction Guide explains how to complete this form.
I 1 Total pages Schedule S; t I!
i
2 FILER' NAME
Jult't ~U\~t+"Z-13 ACCOUNT # (Ethics Commission Filers)
l
4 TOTAL OF UNITEMIZED PLEDGES: ¢ ¢ c:> ¢ ¢ ¢ 1$
5 Date 6 Full name of pledgor o OUI·of-stale PAC(lD#; ) 8 Amount of 19 In-kind description
pledge ($)
I (if applicable)
, .
!
100r address; -~ity; State; Zip Code I
"--NoJt:--~. 1
1
(If travel outside of Texas. complete SChedule T)
10 Principal occupation I Job title (See Instructions) 111 Employer (See Instructions)
I
Date Full name of pledgor o OUI·of·state PAC (ID#;~. ) Amount of I In-kind description
pledge ($)
1
(if applicable) I
, .
I IPledgor address; City; State; Zip Code
I I I
I I I I
L (If travel outside of Texas. complete Schedule T) I
Principal occupation I Job title (See Instructions)
I
Employer (See Instructions) I
Date Full name of pledgor o out·ol-state PAC (10#: ) Amount of I In-kind descriptionI
pledge ($) I (if applicable)
, .
Pledgor address; City; State; Zip Code I
I
I
(If travel outside of Texas. complete Schedule T)
Principal occupation I Job title (See Instructions) l Employer (See Instructions)
Date Full name of pledgor o out·of-slate PAC (10#: ) Amount of I In-kind description
pledge ($) I (if applicable)
Pledgor address; City; State; Zip Code I
I
I
I
I I (If travel outside of Texas. complete Schedule T)
Principal occupation I Job title (See Instructions)
i
Employer (See Instructions)
Date Full name of pledgor o oul·of·slale PAC (l0#:~__~. ) Amount of ! In-kind description
pledge ($) , (if applicable)
i .. !Pledgor address; City; State; Zip Code I
I
I 1I i
II I I
(If travel outside of TeKas. complete Schedule T)
Principal occupation I Job titie (See Instructions) I Employer (See Instructions) I
ATTACH ADOITIONALCOPIES OF THIS SCHEDULE AS NEEDED
I
If contributor is out-of-state PAC, please see Instruction guide for additional reporting requirements.
www.ethics.stale.tx.us Revised 04/21/2010
Texas Ethics Commission PO Box 12070 Austin, Texas 78711-2070 (512)463-5800 (TOO 1-800-735-2989)
LOANS
The Instructi on Guide explains how to complete this 11
:
2 FILER NAME
JlAli e
'3
Sc.hul-t"l-I
,
4
TOTAL OF UNITEMIZED LOANS: ::::> ¢ ¢ ¢ ¢ ¢
5 Dale of loan 7 Name oflender o out-of-state PAC (10#:
5-Co-11 .J~l~(. s:~~~~<-. .. . . . .
6 Is lender 8 Lender address; City; State; Zip Code
a financial ~ZOa l J...!sb~<--L ~(C)-c:,Institution?
y ~) Col\e,\.e Stct~r-1 ~ \l8t-/-':l'-
12 P",o,,,,,, ~_'oo '"""'". IS~""""-. j'13 Em"",,, IS~ '0'"","",.,
14 Description of Collateral
JO.!.Go none -
15 GUARANTOR 16 Name of guarantor
INFORMATION
. . . . . . ...
17 Guarantor address;
not applicable
19 Principal Occupation (See Instructions)
Date of loan Name oflender
. . . . ...
Is lender Lender address; City;
a financial
Institution?
y N I
Principal occupation I Job title (See Instructions)
Description of Collateral
o none
GUARANTOR
INFORMATION
o not appiicabie
Name of guarantor
Guarantor address;
Principal Occupation (See Instructions)
. . . -. . . -.. ~ . . . . .
City; State; Zip Code
120
i
Employer (See Instructions)
o out-of-state PAC (10#:___
. . . . . . ...
State; Zip Code
Employer (See Instructions)
City; State; Zip Code
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
SCHEDULE E
pages Schedule E:
r
ACCOUNT # (Ethics Commission Filers)
I
I$;r --
)19 Loan Amount ($)
,
-f..'t 3~O .~I
I 10 Interest rate
: 0
: 11 Maturity date
I J!-A.
r
18 Amount Guaranteed ($)
~.
)l LoanAmount ($)
I
'1 Interest rate
i
I Maturity date
If lender is out-of-state PAC. please see instruction guide for additional reporting requirements.
www_ethics.state.tx.us Revised 04121/2010
Texas Ethics Commission PO Box 12070 Austin, Texas 78711-2070 (512) 453-5800 (TDD 1-800-735-2989)
POLITICAL EXPENDITURES SCHEDULE F
Advertising Expense
Accounting/Banking
Consulting Expense
Event Expense
Fees
EXPENDITURE CATEGORIES FOR BOX 8(a)
GiftfAwards/Memorials Expense Salaries/Wages/Contract Labor Loan RepaymenUReimbursement
Legal Services SolicitationlFundraising Expense Transportation Equipment & Related Expense
Food/Beverage Expense Travel In District Contributions/Donations Made By
Polling Expense Travel Out Of District Candidate/Officeholder/Political Committee
Printing Expense Office OverheadlRental Expense OTHER (enter a category not listed above)
The Instruction Guide explains how to complete this form. ,
1 Total pages Schedule F:
I
!3 ACCOUNT # (Ethics Commission Filers) I
FILER NAME J L.\ \ l e S-Lh.\.A. l+-L.
~--------------~----------------------------_'4 Date
4-2-l-ll Payee name C .C. L('eL+ l en s i
6 Amount ($) : 7 Payee address; City; State: Zip Code
12~'4r.f. ± l50Q ~i l~ A'Vre;.
i3~~.W ''''t30~
8 PURPOSE i (a) Categor/ (See categories listed at the top of this schedule) (b) Description (If travel outside ofTexas. complete Schedule T)
OF
EXPENDITURE I ~Ve(-l-i'S\{\, ~~(\3e:..-
9 Complete OOJ.Y If direct
expenditure to benefit CIOH
Candidate / Officehorc:ler name \
Date
'5 -2-l'
I Payee name
i ~ lk \J.s.i.-k-6.10411
5(',(""\.5
Office sought Office held
Amount ($) Payee address; City; State\ Zip Code
\2~ E, ~, J. ~'(~ r.v"....u,
t3~I" l ""k It ~'"")
Category (!iee categones\i5ted at the top at this schedule) I Description (If travel outsioe ofTexas, complele Scheoule T)PURPOSE
OF
EXPENDITURE Atvex--k ~ \A0 tx.peJ'\----=!;:....;:€-:::.:.-..-_L....1'---:-M:--C-I__'--=-ler-=-.;.s=--______---l
Candidate / Offic~lder nache Office sought Office heldComplete OOJ.Y if direct
expenditure to benefit C/OH
Date 5-~-ll
Amount ($)
~211.~
PURPOSE
OF
I EXPENDITURE
Complete Q.W.Y if direct
expenditure to benefit C/OH
Payee name
C ,C. Cre.~h'of\~ ~~~~~------------------------------~ Payee address; City; State; Zip Code
\EK:x.:> ~('lo~ kcz.
"F-o." A,.I -rx. I~&01
CategorY (See categonles lisled at the top of this schedule) Description (If travel outside ofTexas, complete Schedule T)
ALve.c-hs·\ ~ T=W:rb
Candidate / Officehoftjer name Office sought Office held
I---D~5_~e-_.~4-._-__l_l---l-i_pa__ye_en_am~_e_\N_._T~'vi
Amount ($) I Payee address; City; State: Zip Code I +'5<Ol,~ 2.toc> ~'-1<IAi7~ftiy$ j ~-ll<' ~o.::::::,
___.__ l C;/ll~ e.-$"t~;-g~~--tlF--')t~Y-S____ _ .... ··PURPOSE . I Category (See cate(o:ies listed allhe lop of Ihis schedule) Description (If travel outside ofTexas. complele SChedule T)
I
i
. EXPE~6,TURE A dv<.,(~'I :)",-,-,;{""\.;--'-,+-___._---l___...E-4-U---lO--A.c--...!C.5----------JrComplete ONLY if direct Candidate I Officeholder narn'e Office sought Office held
expenditure to benefit C/OH
---.~--.------
ATTACH ADDITIONAL COPIES OF THIS SCHEDULI;:AS NEEDED
www.ethics.staie.tx.us Revised 04/21/2010
Texas Ethics Commission PO Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
I
I
POLITICAL EXPENDITURES
MADE FROM PERSONAL FUNDS
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense GiftJAwardslMemonals Expense Salaries/Wages/Contract Labor Loan RepaymenUReimbursement
Accounting/Banking Legal Services Solicitation/Fundraising Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Travel In District Contributions/Donations Made By
Event Expense Polling Expense Travel Out Of District Candidate/Officeholder/Political Committee
Fees Printing Expense Office Overhead/Rental Expense OTHER (enter a category not listed above)
The Instruction Guide explains how to complete this form.
I
1 Total pages Schedule G: 12 FILER NAMEJ l' S"'~\A l+zi
3 ACCOUNT # (Ethics Commission Filers)
1 I lA.\e... I
,
4 Date 5 Payee name
I
,
S Amount ($) '7 Payee address; City; State; Zip Code
J~~~Reimbursement from
I
political contributions
__________,-I [] in_t~_d_~ ___________________________________
'8 PURPOSE I(a) Category (See categories listed at the top of this schedule) '-rescriPti~n (If travel outside ofTexas, complete Schedule T)
OF
I EXPENDITURE
I i
Date Payee name
Amount ($)
.----.
Payee address; City; State; Zip Code
[] Reimbursement from
political contributions
intended i
Category (See categories listed at the lop of this schedule) Description (If travel outSide ofTexas.complete Schedule T)PURPOSE
OF
EXPENDITURE
I
Date Payee name
I I
I
Amount ($) Payee address; City; State; Zip Code
I
0 Reimbursement from
political contributions
intended I
u,,~~,'>'''VB (If travel outside of Texas, complete Schedule T)PURPOSE
OF
F'
Date
Payee address; City; State; Zip CodeAmount ($)
Reimbursemen.{ from
poiitical conll iUl..Itions
intended
,.. (See calegorieslisted at the tap of :his I (if trzvel outside of Texas, complete Schedule T)PURPOSE
OF
EXPENDITURE
l
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.stale.tx.us Revised 04/2112010
I
Texas Ethics Commission PO Box 12070 Austin, Texas 78711·2070 (512) 463-5800 (TDD 1·800.735-2989)
PAYMENT FROM POLITICAL CONTRIBUTIONS SCHEDULE HTO A BUSINESS OF C/OH
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense GiftJAwaros/Memorials Expense Salaries/Wages/Contract Labor Loan RepaymenVReimbursement
Accounting/Banking Legal Services Solicitation/Fund raising Expense Transportation Equipment & Related Expense
ConSUlting Expense Food/Beverage Expense Travel In District ContributionslDonations Made By
Event Expense Polling Expense Travel Out Of District Candidate/Officeholder/Political Committee
Fees Printing Expense Office Overhead/Rental Expense OTHER (enter a category nol listed above)
The Instruction Guide explains how to complete this form. I
3 ACCOUNT # (Ethics Commission Filers) 1 Total pages Schedule H: 2 FILER NAME Ju II e
I ,Sc.hu.l+~ 1
4 Date 5 Business name
... -.~-
6 Amount ($) ~d~~'''''')Z', c".
(
PURPOSE ,,,,,eoai the top of this schedule) i (b) Description (If travel outside of Texas, complete Schedule T)8 I'PIOF
EXPENDITURE
I
Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
9 Complete Qti!"Y if direct
B,,~;n ..u. nameDate
Amount ($) ! Busi, address; City; State; Zip Code
I
I
Category (See categories listed at the lop of this schedule) Description (Iftravel outside ofTexas, complete Schedule T)
OF
EXPENDITURE
PURPOSE
I
Candidate I Officeholder name Office sought Office heldComplete Q!iI.:( if direct
expenditure to benefit C/OH
Date Business name
I
Amount ($) Business address; City; State; Zip Code
I
I
PURPOSE I Category (See categories listed at the lOP of this schedule) I Description (lftravel outside ofTexas, complete Schedule Tl
IOF
EXPENDITURE
I i
Candidate I Officeholder name Office sought Office heldComplete Qti!"Y if direct
expenditure to benefit CIOH
1 Business nameDate
i
Amount ($) Business address: City: State: Zip Code
! !
I Catego, (See categories listed at the lOp of this schedule) Description (If travel outside of Texas, complete Schedule T)PURPOSE
OF
EXPENDITURE
I . ~ .~.--. .-~.
Candidate I Officeholder name Office sought Office heldComplete Q!'&'( if direct
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
I
I
I
,
www.ethics.state.tx.us Revised 04/21/2010
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711·2070 (512) 463-5800 (TDD 1-800·735-2989)
NON-POLITICAL EXPENDITURES SCHEDULE IMADE FROM POLITICAL CONTRIBUTIONS
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Gift/Awards/Memorials Expense Salaries/Wages/Contract labor loan RepaymenUReimbursement
Accounting/Banking Legal Services SolicitationlFundraising Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Travel In District Conlributions/Donations Made By
Event Expense Polling Expense Tra vel Out Of District Candidate/Officeholder/Political Committee
Fees Printing Expense Office Overhead/Rental Expense OTHER (enter a category not listed above)
The Instruction Guide explains how to complete this form.
1 Total pages Schedule I: 2 FILER NAMEJ ~t-ku.l t-'l.
1
3 ACCOUNT # (Ethics Commission Filers)
1 Ldte !
4 Date .5 Payee name
I ~.,
_.
6 Amount ($) i~address; City~: Zip Code
( NO t-i 5 )
8 PURPOSE la) Category (See categories lis led al the top of this schedule) (b) Description (See instructions regarding type of information required.)
OF
EXPENDITURE
Date I Payee name
Amount ($) Payee address; City: State; Zip Code
PURPOSE Category (See categories listed at the top of this schedule) Description (See instructions regarding type of intormation required.)
Date Payee name
Amount ($) Payee address; City; State; Zip Code
Category (See categories listed at the top of this schedule) I Description (See instructions regarding type of informalion required.)PURPOSE
! OF
I~~. _,.~II
I Payee name
I
Amount address; City; State; Zip Code
I
!
;>IIRPOSE (See catego;ies listed at the lop a! lhis schedule) Description (See in.structiar,$ re£;ard:ng type of ;nfo~matlon required.)
OF
IEXPENDITURE
ATTACH ADDrTlONAL COPIES OF THIS SCHEDULEAS NEEDED
www.ethic5.state.tx.us Revised 04/21/2010
• Texas Ethics Commission p.o. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
IN-KIND CONTRIBUTION OR POLITICAL EXPENDITURE
FOR TRAVEL OUTSIDE OF TEXAS
SCHEDULE T
The Instruction Guide explains how to complete this form. Total pages Schedule T:
2 FILER NAME ~lA \ \ e. ~c..h.l.A.l+<-.. 3 ACCOUNT # (Ethics Commission Filers)
~---~-------~
4 Name of Contributor I Corporation or Labor Organization I Pledgor I Payee
5 Contribution I Expenditure reported on:
Schedule A Schedule B Schedule C Schedule D
D -,-,Schedule H Schedule N COH-UC COH-T
7 Name of person(s) traveling
8 Departure city or name of departure tocation
6 Dates of travel
9 Destination city or name of destination location
10 Means
Name of Contributor / Corporation Or Labor Organization I Pledgor I Payee
Contribution I Expenditure reported on:
Name of Contributor / Corporation or Labor Organization I Pledgor I Payee
COH-UC COH-T PAC-C D
Dates of travel
D ScheduleA
Schedule H
D Schedule B
D Schedule N
Dates of travel Name of person(s) traveling
Schedule C
C COH-UC
Departure city or name of departure location
Destination city Or name of destination location
Means of transportation Purpose of travel (including name of conference, seminar, or
Contribution I Expenditure reported on:
Schedule A Schedule 8 Schedule C D Schedule D Schedule F
Schedule N
Ioestination city or name of destination location
I ~----~--------~------.-------------------------------------------Means of transportation Purpose of travel (including name of conference, seminar, or other event)
ATIACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.state.tx.us Revised 04121/2010